Programa Saúde da Família
Encyclopedia
The Programa Saúde da Família (PSF), Family Health Program, in Portuguese language
is one of the national public health
programs in Brazil
, which implements a national policy
for primary care
settings with the aim of substituting part of the traditional model of primary care based on medical specialists. As its name says, its main focus is on families
instead of individuals, and it is organized around multidisciplinary Family Health Teams, formed by a core of professionals such as physician
s, nurses, dentist
s, psychologist
s and social work
ers, as well as community health agent
s, a kind of "barefoot doctor".
Brazil has currently (August 2009) approximately 30,000 of these teams, deployed in 5,241 of its 5,656 municipalities. The population coverage by PSF is 96.1% (a total of more than 141 million inhabitants). A total of 5,339 municipalities have 230,000 community health agents.
PSF is now considered one of the main strategies of universal health care
, service reorganization and reorientation of professional practice at this level of care, as well as a platform for health promotion
, disease prevention and rehabilitation
. Annual federal investments in the Program amount to ca. 2.5 billion US dollars.
, with its intent of increasing the accessibility of health to all, and to enhance the actions of prevention and health promotion. In that year, PACS, a program for training and deploying of community health agent
s was started. After many theoretical discussions and preparations, the program was launched by the Ministry of Health
in 1994, as part of the so-called Sistema Único de Saúde
(SUS), or Unified Health Care System, the most ambitious initiative of the Brazilian federal government to establish a hierarchically-organized and rationally funded program of public health, which is responsible for providing care to 75% of Brazil's current population of approximately 190 million inhabitants.
The Program expanded rapidly and, in 2006. recognizing its importance, the federal government issued the Decree No. 648 of March 28, 2006, where it was established that PSF was going to be a strategic priority of the Ministry of Health to organize primary care in the country, and the main tool to enable universal and continuing access to health services under the basic principles of SUS: universality
, equity
, decentralization
, comprehensiveness, and community
participation. The unique identification and central registry of all citizens of the country, using a so-called SUS Card, was to be one of its main organization supports. In its most recent development, a program for establishing in each region a Health Family Support Nucleus (NASF: Núcleo de Apoio à Saúde da Família) was started by the federal government in cooperation with state and municipal governments, In addition, a system of SUS Schools (training schools in several cities and states) was established, in order to provide the buildup and training of the huge specialized workforce required by SUS and PSF. The initial training of community health agents is part of its mission.
PSF has, so far, produced a positive impact on the direction of this new model of health care and prevention, but it still has not been able to completely substitute the former model, based in an overvaluation of the practices of curative care
, medical specialists and hospital
s, with its emphasis on an excess of technological procedures and drug
s, leading to high costs. This traditional model has resulted in an undesired fragmentation of care. PSF strives to offer integrated health care focused on the family, instead of individuals, but the penetration of the model is still incomplete in most of the cities.
Based on this same ordinance, the composition of family health teams was established, and its scope of action was defined as restricted to a maximum of 4,000 inhabitants (approximately 1,000 families). The core team consisted minimally of a physician, a nurse, several nursing assistants (or practical nurses) and several community health agents. The team has 30 working hours per week for all members. Several Brazilian cities hire other professionals such as dentist
s, pharmacist
s, nutritionist
s, physical educators, psychologist
s, physiotherapists, speech therapists, occupational therapist
s, etc.
Portuguese language
Portuguese is a Romance language that arose in the medieval Kingdom of Galicia, nowadays Galicia and Northern Portugal. The southern part of the Kingdom of Galicia became independent as the County of Portugal in 1095...
is one of the national public health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
programs in Brazil
Brazil
Brazil , officially the Federative Republic of Brazil , is the largest country in South America. It is the world's fifth largest country, both by geographical area and by population with over 192 million people...
, which implements a national policy
Policy
A policy is typically described as a principle or rule to guide decisions and achieve rational outcome. The term is not normally used to denote what is actually done, this is normally referred to as either procedure or protocol...
for primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
settings with the aim of substituting part of the traditional model of primary care based on medical specialists. As its name says, its main focus is on families
Family
In human context, a family is a group of people affiliated by consanguinity, affinity, or co-residence. In most societies it is the principal institution for the socialization of children...
instead of individuals, and it is organized around multidisciplinary Family Health Teams, formed by a core of professionals such as physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s, nurses, dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
s, psychologist
Psychologist
Psychologist is a professional or academic title used by individuals who are either:* Clinical professionals who work with patients in a variety of therapeutic contexts .* Scientists conducting psychological research or teaching psychology in a college...
s and social work
Social work
Social Work is a professional and academic discipline that seeks to improve the quality of life and wellbeing of an individual, group, or community by intervening through research, policy, community organizing, direct practice, and teaching on behalf of those afflicted with poverty or any real or...
ers, as well as community health agent
Community health agent
Community health agent is the title of a specific lay health care worker developed in Brazil by way of PACS in 1991 as part of the construction of the Brazilian Unified Health System established by Constitutional rule in 1988.The agent, which was said to be inspired on the barefoot...
s, a kind of "barefoot doctor".
Brazil has currently (August 2009) approximately 30,000 of these teams, deployed in 5,241 of its 5,656 municipalities. The population coverage by PSF is 96.1% (a total of more than 141 million inhabitants). A total of 5,339 municipalities have 230,000 community health agents.
PSF is now considered one of the main strategies of universal health care
Universal health care
Universal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
, service reorganization and reorientation of professional practice at this level of care, as well as a platform for health promotion
Health promotion
Health promotion has been defined by the World Health Organization's 2005 Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health"...
, disease prevention and rehabilitation
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
. Annual federal investments in the Program amount to ca. 2.5 billion US dollars.
History
PSF as a concept originated in 1991, as a part of the reform of the health care sector demanded by the new Constitution of BrazilConstitution of Brazil
During its independent political history, Brazil has had seven constitutions. The most recent was ratified on October 5, 1988.-Imperial Constitution :Background...
, with its intent of increasing the accessibility of health to all, and to enhance the actions of prevention and health promotion. In that year, PACS, a program for training and deploying of community health agent
Community health agent
Community health agent is the title of a specific lay health care worker developed in Brazil by way of PACS in 1991 as part of the construction of the Brazilian Unified Health System established by Constitutional rule in 1988.The agent, which was said to be inspired on the barefoot...
s was started. After many theoretical discussions and preparations, the program was launched by the Ministry of Health
Ministry of Health (Brazil)
The Ministry of Health is one of many the Brazilian federal government ministries.Created on July 25, 1953 as the Ministry of Education and Health , today it is effectively divided into three distinct official organs: Health, Education, and Culture.-External links:*...
in 1994, as part of the so-called Sistema Único de Saúde
Sistema Único de Saúde
The Sistema Único de Saúde is Brazil's publicly-funded health care system. SUS was created after the Brazilian Constitution of 1988, which assured that health care is a "right of all and an obligation of the State" . Prior to that, only people who contributed with the social security were able to...
(SUS), or Unified Health Care System, the most ambitious initiative of the Brazilian federal government to establish a hierarchically-organized and rationally funded program of public health, which is responsible for providing care to 75% of Brazil's current population of approximately 190 million inhabitants.
The Program expanded rapidly and, in 2006. recognizing its importance, the federal government issued the Decree No. 648 of March 28, 2006, where it was established that PSF was going to be a strategic priority of the Ministry of Health to organize primary care in the country, and the main tool to enable universal and continuing access to health services under the basic principles of SUS: universality
Universality
Universality may refer to:* Universality in physical science * Universality * Universality , meaning present in all places and all times* Universality...
, equity
Equity (economics)
Equity is the concept or idea of fairness in economics, particularly as to taxation or welfare economics. More specifically it may refer to equal life chances regardless of identity, to provide all citizens with a basic minimum of income/goods/services or to increase funds and commitment for...
, decentralization
Decentralization
__FORCETOC__Decentralization or decentralisation is the process of dispersing decision-making governance closer to the people and/or citizens. It includes the dispersal of administration or governance in sectors or areas like engineering, management science, political science, political economy,...
, comprehensiveness, and community
Community
The term community has two distinct meanings:*a group of interacting people, possibly living in close proximity, and often refers to a group that shares some common values, and is attributed with social cohesion within a shared geographical location, generally in social units larger than a household...
participation. The unique identification and central registry of all citizens of the country, using a so-called SUS Card, was to be one of its main organization supports. In its most recent development, a program for establishing in each region a Health Family Support Nucleus (NASF: Núcleo de Apoio à Saúde da Família) was started by the federal government in cooperation with state and municipal governments, In addition, a system of SUS Schools (training schools in several cities and states) was established, in order to provide the buildup and training of the huge specialized workforce required by SUS and PSF. The initial training of community health agents is part of its mission.
PSF has, so far, produced a positive impact on the direction of this new model of health care and prevention, but it still has not been able to completely substitute the former model, based in an overvaluation of the practices of curative care
Curative care
Curative care or curative medicine is the kind of health care traditionally oriented towards seeking a cure for an existent disease or medical condition...
, medical specialists and hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s, with its emphasis on an excess of technological procedures and drug
Drug
A drug, broadly speaking, is any substance that, when absorbed into the body of a living organism, alters normal bodily function. There is no single, precise definition, as there are different meanings in drug control law, government regulations, medicine, and colloquial usage.In pharmacology, a...
s, leading to high costs. This traditional model has resulted in an undesired fragmentation of care. PSF strives to offer integrated health care focused on the family, instead of individuals, but the penetration of the model is still incomplete in most of the cities.
Characteristics
According to this decree the following characteristics were defined for the Family Health Program:- Maintain a central registryRegistry-Computing:* Windows Registry, a database of configuration settings in Microsoft Windows operating systems* Domain name registry, an organization that manages the registration of top-level internet domain names...
of families and individuals and use consistently its data to analyze the health situation of the community, taking into account the social, economic, cultural, demographic and epidemiological characteristics of the territory; - Define the territory of operation, and carry out mapMapA map is a visual representation of an area—a symbolic depiction highlighting relationships between elements of that space such as objects, regions, and themes....
ping and reconnoitering the delimited area, in order to understand that particular segment of the population, with continuous updating; - Perform the assessment, planningPlanningPlanning in organizations and public policy is both the organizational process of creating and maintaining a plan; and the psychological process of thinking about the activities required to create a desired goal on some scale. As such, it is a fundamental property of intelligent behavior...
and implementation of health care activities based on the knowledge about health risks, thus being able to prioritize solutions to the more prevalent health problems of families; - Practice extended family careFamily medicineFamily medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...
, effected through the knowledge of the structure and function of families, proposing interventions that will influence effectively the processes of healthHealthHealth is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
and illnessIllnessIllness is a state of poor health. Illness is sometimes considered another word for disease. Others maintain that fine distinctions exist...
of individuals, families and the community; - Promote interdisciplinary teamworkTeamworkTeamwork is action performed by a team towards a common goal. A team consists of more than one person, each of whom typically has different responsibilities....
, integrating technical and professional areas of different backgrounds; - Promote and develop partnerships with community agents and integrate with social projects, with the aim of promoting health in accordance with priorities and under the coordination of municipal management;
- Assess different knowledge and practices from the perspective of a holistic and problem solvingProblem solvingProblem solving is a mental process and is part of the larger problem process that includes problem finding and problem shaping. Consideredthe most complex of all intellectual functions, problem solving has been defined as higher-order cognitive process that requires the modulation and control of...
approach, enabling the creation of bonds of trust with ethicsEthicsEthics, also known as moral philosophy, is a branch of philosophy that addresses questions about morality—that is, concepts such as good and evil, right and wrong, virtue and vice, justice and crime, etc.Major branches of ethics include:...
, commitment and respect; - Promote and encourage community participation in the social controlSocial controlSocial control refers generally to societal and political mechanisms or processes that regulate individual and group behavior, leading to conformity and compliance to the rules of a given society, state, or social group. Many mechanisms of social control are cross-cultural, if only in the control...
, planning, implementation and evaluation of actions, and - Perform systematic monitoring and evaluation of actions implemented, in order to readjust and improve the whole process.
Based on this same ordinance, the composition of family health teams was established, and its scope of action was defined as restricted to a maximum of 4,000 inhabitants (approximately 1,000 families). The core team consisted minimally of a physician, a nurse, several nursing assistants (or practical nurses) and several community health agents. The team has 30 working hours per week for all members. Several Brazilian cities hire other professionals such as dentist
Dentist
A dentist, also known as a 'dental surgeon', is a doctor that specializes in the diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aides in providing oral health services...
s, pharmacist
Pharmacist
Pharmacists are allied health professionals who practice in pharmacy, the field of health sciences focusing on safe and effective medication use...
s, nutritionist
Nutritionist
A nutritionist is a person who advises on matters of food and nutrition impacts on health. Different professional terms are used in different countries, employment settings and contexts — some examples include: nutrition scientist, public health nutritionist, dietitian-nutritionist, clinical...
s, physical educators, psychologist
Psychologist
Psychologist is a professional or academic title used by individuals who are either:* Clinical professionals who work with patients in a variety of therapeutic contexts .* Scientists conducting psychological research or teaching psychology in a college...
s, physiotherapists, speech therapists, occupational therapist
Occupational therapist
An occupational therapist is trained in the practice of occupational therapy. The role of an occupational therapist is to work with a client to help them achieve a fulfilled and satisfied state in life through the use of "purposeful activity or interventions designed to achieve functional...
s, etc.
External links
- Official website of the Brazilian Ministry of Health (In Portuguese)
- Chronology of Family Health Program (In Portuguese)
See also
- Family medicineFamily medicineFamily medicine is a medical specialty devoted to comprehensive health care for people of all ages. It is a division of primary care that provides continuing and comprehensive health care for the individual and family across all ages, sexes, diseases, and parts of the body...
- Community health agentCommunity health agentCommunity health agent is the title of a specific lay health care worker developed in Brazil by way of PACS in 1991 as part of the construction of the Brazilian Unified Health System established by Constitutional rule in 1988.The agent, which was said to be inspired on the barefoot...
- Universal health careUniversal health careUniversal health care is a term referring to organized health care systems built around the principle of universal coverage for all members of society, combining mechanisms for health financing and service provision.-History:...
- Primary Health CentrePrimary Health CentreThe Primary Health Centre is the basic structural and functional unit of the public health services in developing countries. PHCs were established to provide accessible, affordable and available primary health care to people, in accordance with the Alma Ata Declaration of 1978 by the member...